What Is IBS (Irritable Bowel Syndrome)

What is IBS ?Irritable bowel syndrome is a functional disorder affecting the digestive system, characterized by abdominal cramping and pain often accompanied by variations in the bowel movements such as diarrhea or constipation.

  • Abdominal cramping and pain, gas and bloating are the usual symptoms. Either constipation or diarrhea may be present.
  • Symptoms of irritable bowel syndrome are triggered by various factors such as emotional stress and anxiety, as well as certain food items
  • Typical symptoms of IBS may be sufficient for diagnosis, but further investigations are done to eliminate other possible causes with similar symptoms.
  • Symptoms can be treated with appropriate drugs; regularity in dietary habits may help avoid the development of symptoms.

Irritable bowel syndrome or IBS is a functional disorder and is different from inflammatory conditions such as Crohn’s disease. There are no structural changes or abnormalities associated with this condition; the intestines look normal in imaging tests like x-rays and when viewed with endoscope. The symptoms are caused by certain abnormalities in the movement of the intestines and the workings of the nerves associated with the digestive system.

IBS is a very common condition occurring in about ten to fifteen percent of people irrespective of gender, but some studies have shown that women having the symptoms approach the doctor more frequently than men. Among the digestive disorders brought to the attention of gastroenterologists, IBS is usually the most probable condition diagnosed. Since the structural abnormalities usually associated with the different disorders of the digestive system are absent in the case of IBS, it is mainly diagnosed by the symptoms alone. There are no specific tests to identify the condition; tests only help to confirm the diagnosis by eliminating the possibility of other diseases.

Causes

The exact reason for the occurrence of IBS is unknown but an oversensitivity of the digestive system to various stimuli is regarded to be causing the symptoms. People who have IBS are affected by contractions of the gastro intestinal muscles and gas in the digestive tract more than other people, who generally feel no great discomfort from such frequent occurrences during the digestive process. Abnormal intestinal movements are considered to be the reason for alterations in the bowel movements such as diarrhea and constipation associated with IBS, but it is not necessarily so in all cases. Abnormal contractions are not present in all those who have IBS and even when they are present, the symptoms do not always occur at the same time.

Minor irritants, both emotional and physical stress, and changes in the diet, both in quantity and timings, are known to bring about episodes of symptoms or worsen existing symptoms. Emotional stress, depression, fear and anxiety often act as triggers. Heavy meals, diet rich in fats, consumption of tea or coffee, dairy products, wheat and citrus fruits are just a few of the dietary factors known to cause flare ups. Eating meals hurriedly, and going without food for longer than usual periods of time, also aggravate the condition. Since the reactions to certain foods are not always consistent, it is difficult identify and avoid irritants. It is not always a specific food allergy which causes symptoms but at different times, different substances precipitate adverse reactions. The reason for inconsistencies in the body’s reaction to the same agents is still not understood.

Symptoms

Symptoms of IBS usually start appearing in the teenagers and people in the early twenties. The symptoms appear without any warning and often disappear without any medication. The episodes recur frequently and unpredictably but they usually occur only when he person is conscious and awake. They rarely disturb sleep. IBS can start developing later in life too, but it is much less common than the early onset of the disease.

The most common symptom of IBS is abdominal cramping and pain which almost always gets relieved when the person has a bowel movement. The frequency of bowel movements and the consistency of stool keep changing. Distention or bloating of the abdomen and feeling of fullness in the rectum even after a bowel movement are some of the features of this condition. The stool may contain mucus too. Pain in the lower abdomen may be sharp and intermittent like cramps or it may be a dull constant ache lasting over a period of time. Nausea, gas, headache, depression general fatigue and anxiety are other symptoms usually found along with pain and bloating of the abdomen. The severity and duration of symptoms may change from time to time but some pattern may emerge with regard to the triggers that precipitate the symptoms and changes in the bowel movements.

Diagnosis

There may not be any outward symptoms in a person which indicate the presence of IBS. The doctor may not detect any abnormalities during a physical examination too, except for a slight tenderness felt when pressing the area above the large intestine. Several tests are done including stool tests, blood tests and viewing test such as colonoscopy or sigmoidoscopy. These tests are not for detecting IBS but to ensure that the person is not having other inflammatory diseases such as ulcerative colitis, Crohn’s disease, lymphocytic or collagenous colitis etc., which have symptoms similar to those of IBS. Colon cancer is another disease to be ruled out. If the person is having IBS and no other disorder, the test results will be normal. However, invasive tests like sigmoidoscopy usually result in the worsening of the symptoms in people who have IBS.

In people 40 years and older, the risk of inflammatory diseases and cancer are higher; hence more tests, including abdominal scans, x-rays, and colonoscopy, are conducted. If certain other symptoms such as bloody stools or bleeding from the rectum, fever, and vomiting or weight loss are also present, in addition to the typical symptoms of IBS, detailed testing is necessary. In a person diagnosed with IBS, other digestive disorders such as gastric ulcers, appendicitis, cancer or gall bladder disease may develop eventually as the person gets older. The additional symptoms precipitated by the new developments should be taken seriously and investigations should be conducted. Any change in the pattern or severity of existing symptoms also should be brought to the attention of the doctor.

What Is IBS Treatment

Treatment depends on the symptoms and the conditions which trigger flare ups in different people. If the triggers are identified, they can be avoided as much as possible. If emotional stress is aggravating the disease, people should learn ways to avoid such stressful situations or learn techniques to handle stress such as yoga, meditation, breathing exercises etc. Constipation can be avoided by physical activity on a regular basis, in addition to following a fiber-rich diet.

 A simple diet with regularity in mealtimes is ideal for managing irritable bowel syndrome. Several smaller meals evenly distributed throughout the day may be better than having two or three heavy meals. Cabbage, beans, and other food items which are hard to digest, and are known to produce gas, should be avoided by people who have complaints such as abdominal bloating and flatulence. Certain food additives like sorbitol, which is used as a sweetening agent in dietetic food items and chewing gums as well as in certain drugs, should be avoided as much as possible. Fruit sugar known as fructose, abundant in berries and as a food additive in some sweets, should be consumed in small quantities only. A diet low in fat content is found to be beneficial for some people who have frequent motions. If a person is lactase deficient in addition to having irritable bowel syndrome, lactose rich food items, mainly milk and milk products, should be avoided or taken in small quantities.

A diet rich in fiber content is usually sufficient to tackle constipation, but addition of bran to the diet or taking spsyllium preparations help in keeping the stool smooth. It is very important to take plenty of fluids and water while taking psyllium and extra bran. Bloating and flatulence are side effects of taking extra fiber. They may be avoided by taking methyl cellulose instead, which is a synthetic fiber product.

Some laxatives can be used safely to relive constipation. Drugs which contain lactulose, sorbitol or polyethylene glycol are usually used. Stimulant laxatives which contain glycerin or bisacodyl, as well as a new drug named lubiprostone, are also found to be beneficial.

Abdominal pain can be treated with muscle relaxants that work on the gastrointestinal muscles. Dicyclomine is effective in reducing pain, but being an anticholinergic drug, it may precipitate many side effects including blurring of vision, difficulty in passing urine and dry mouth.

The drugs loperamide or diphenoxylate are usually used to relieve diarrhea. Another drug used is alosetron which reduces the effect of the neurotransmitter serotonin. Peppermint oil is an active ingredient in formulations which help reduce abdominal cramping and flatulence. Cognitive-behavioral therapy, hypnosis, and other techniques to change behavior patterns are found to be effective in managing symptoms in people with IBS. Psychotherapy and antidepressants are included in the clinical options for managing IBS. Antidepressants in small doses are found to be effective in relieving not only the emotional symptoms such as anxiety, depression and sleep problems but also many of the physical symptoms like abdominal pain and cramping.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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